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Update
Vol. 28, Issue 1
2016
The Council for Accreditation in Occupational Hearing Conservation
Potential Contributions of Recreational Noise
to Daily Noise Dose
By: Colleen G. Le Prell, PhD
Damaging sounds are most often associated with occupational noise
sources, such as machinery or tools, or noise exposure associated with
military duties. The occupational or military hearing conservationist
likely has a reasonable understanding of individual noise risk based on
dosimetry, noise mapping, or other records. However, noise exposure
does not necessarily end with the end of the workday. Some individuals
participate in activities such as listening to loud music (at concerts, clubs,
or on devices), attending sporting events in loud stadiums, using power
tools during home improvement projects or lawn care, using firearms
during hunting or target practice, and so on. With the exception of
unprotected firearm use, exposure to any one of these non-occupational
sources is not likely to be immediately damaging as exposures are
typically briefer and/or less frequent than the levels thought to cause
acute permanent injury and hearing loss. None the less, understanding
that a worker’s total daily sound exposure may continue to increase after
leaving the workplace is critical. The extent to which other ongoing
sounds contribute to total daily exposure is an important educational
concept to share with those enrolled in a hearing conservation program.
There is generally unanimous agreement that there is a dose-response
relationship in which higher levels and longer durations of sound
exposure are increasingly hazardous (OSHA, 1983; NIOSH, 1998).
Given that general assumption, it should be clear that non-occupational
noise has the potential to increase total exposure and thereby increase
an individual’s risk, particularly in cases where the recreational sound
source is encountered frequently. The remainder of this article
Content
Page
Potential Contributions of Recreational Noise
to Daily Noise Dose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Message from the Chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
The Importance of Detecting Temporary Threshold Shifts . . . . . . . 4
The Effect of Education on the Decision to Wear Ear Plugs . . . . . . 5
The Council for Accreditation in
Occupational Hearing Conservation . . . . . . . . . . . . . . . . . . . . . . . . . 7
Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
discusses sound levels at common recreational venues. In interpreting
the potential risk of any single recreational event, readers are reminded
of the cautionary note by Behar (2007), who notes that noise risk
standards are to be applied over years, not hours. It is the repetition
of noise dose exceeding 100% on a daily basis throughout a working
career that is hazardous, not the single instance in which a noise dose
exceeds 100% (although very high sound levels can induce acoustic
trauma, including permanent hearing loss, after a single exposure). In
other words, exposures at noise at periodic recreational events are not
necessarily by themselves hazardous even if dose exceeds 100%, but
these exposures would become hazardous with repetition. Moreover,
they add to the total daily or weekly dose that a person might accrue
during the work-day or work-week, and do thus increase a given worker’s
total risk of noise-induced hearing loss (NIHL).
Concerts. The two most common non-occupational mass noise exposures
reported in a recent survey of New York City residents were concerts and
sporting events, with an estimated annual duration of event attendance
of approximately 50 hours per year (Neitzel et al., 2011). In an early
report, Cabot et al. (1979) conducted sound level measurements at
multiple establishments and reported average levels for live rock music
were ~95 dBA across venues (ranging from 78-115 dBA). Opperman
and colleagues (2006) more recently measured sound levels at a pop
concert (360 min), a rock concert (210 min), and a rock-a-billy concert
(195 min). The average sound levels reached or exceeded 95 dBA,
regardless of music type, at every location measured within the venue
hall. In some locations, average levels were as high as 102-107 dBA.
Given event durations of 3-4 hours, exposures like these reach or exceed
daily occupational noise exposure limits. A person’s total daily noise
exposure would depend on the noise levels experienced at work, time
spent at an evening concert, and sound level at their location within
the concert venue. If the concert were a weekend event, total weekly
exposure would increase relative to 5-day per week assumptions.
Nighclubs/Discotheques. Cabot et al. (1979) reported average
sound levels of ~85 dBA across venues (ranging from 71- 93 dBA).
Sound levels were higher in a more recent study reporting levels in 10
nightclubs around the Sydney, Australia area. Average levels across the
clubs were reported to be ~98 dB equivalent continuous A-weighted
sound pressure level (LAeq), and individual clubs had measured levels
ranging from ~91 to ~106 dB LAeq (Williams et al., 2010). Recent
sound level measurements in a German discotheque revealed average
sound levels of 102 dBA (Müller et al., 2010). Values are similar in
continued on page 3
CAOHC
update
2
Update
Published by the Council for Accreditation
in Occupational Hearing Conservation, a
not-for-profit organization dedicated to the
establishment and maintenance of training
standards for those who safeguard hearing
in the workplace.
Articles should be submitted with a
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• Editor:
Antony Joseph, AuD PhD CPS/A
• Publications Committee Chair:
Ted Madison, MA CCC-A
•
Committee Members:
Pamela duPont, MS CCC-A CPS/A
Charles Moritz, MS INCE Board Cert.
Kimberly Riegel, PhD
2016—Vol. 28, Issue 1
Message from the Chair
By: D. Bruce Kirchner, MD MPH CPS/A
The past two years have been a gratifying experience for me serving as your Chair. CAOHC
continues to take steps to expand its mission of “Advance best practice in occupational hearing
conservation worldwide.” In thinking about a subject for this message, I reflected on this
mission and found it to be daunting in nature. Certainly the task of advancing best practices is
a challenge, in that many of us probably have a different opinion on what is best. How can we
ever establish a consensual, defensible position on best practice? Even more so advancing these
practices worldwide? Taking on the world is not something most of us are willing to sign up for!
The Council can agree on one point, our mission is definitely aspirational in nature. Through
the Council’s strategic planning process, we take time at each face-to-face meeting and try to
come up with an approach to move our mission forward. We are currently putting together a
committee to start discussing best practices in occupational hearing conservation. We are thinking
of ways we can work through different organizations in countries outside the United States. I
believe CAOHC is the best organization to take on the task of globally expanding our reputation
in the training and certification of individuals involved in occupational hearing conservation.
One thing I did want to accomplish during my tenure was to work toward solidifying our
structure. By that I mean insuring all our by-laws and policies are up-to-date and in line with
our mission and certification program goals, and legally defensible. All non-profit organizations
need to continually pay attention to these issues and I believe we have made good progress in
this area which will help sustain us through the future.
• Executive Director:
Kim Stanton, CAE
I am handing off the chair position to a person I have worked with for many years, and who
has dedicated her life to occupational hearing conservation, Dr Laurie Wells. Laurie is a proven
leader, so I have no doubt that CAOHC is in excellent hands. Be looking for a Chair’s Message
from Laurie in the next Update.
•
Finally, I want to tell you what a great group of people CAOHC has for representing the
professional organizations on the Council, as well as the strong management staff we enjoy.
They are all dedicated people always willing to volunteer when needed. To the rest of you who
are volunteers for CAOHC, we cannot thank you enough!
Administrative Staff:
Sarah Atkins
Marina Pappas
Chris Whiting
• Graphic Designer:
Jennifer Gubbin
Opinions expressed in UPDATE are those
of the authors, and do not necessarily reflect
official CAOHC policy. © CAOHC 2008
Opt-Out Option
If you wish to have your name removed
from Update mailing list, please notify
CAOHC Administrative Office at (414)
276-5338; or email [email protected].
D. Bruce Kirchner, MD, MPH CPS/A; Occupational Physician. Dr. Kirchner is the Global Medical
Leader for Procter & Gamble’s Household Care business, with responsibilities in assuring the
occupational health of 30,000 employees in manufacturing and research. Additionally, he is the
system owner for hearing conservation across the company. He retired from the U.S. Army in 1995
after 21 years of service in which he was involved in hearing conservation in field units, as well
as industrial operations. Dr. Kirchner has a B.A. in English from the Virginia Military Institute,
an M.D. from the University Of Pittsburgh School Of Medicine, and an MPH from the University
Of Pittsburgh School Of Public Health. He is board certified in Internal Medicine, Occupational
Medicine, and Preventive Medicine & Public Health. Dr. Kirchner is a Member Delegate to the
National Hearing Conservation Association Executive Council. He is also a Fellow of the American
College of Occupational and Environmental Medicine and was recently appointed to the Council for
Accreditation in Occupational Hearing Conservation as a Council Member representing ACOEM.
You can contact Bruce Kirchner at: [email protected]
CAOHC
2016—Vol. 28, Issue 1
update
3
– continued from page 1: Potential Contributions of Recreational Noise to Daily Noise Dose...
studies originating in the United Kingdom (101 dBA; see Smith et al.,
2000), and Argentina (104-112 dBA, see Serra et al., 2005). Müller et
al. (2010) reported that 3 hours/week was a typical discotheque visit
time, whereas Williams et al. (2010) reported typical visit times of
5 hours/week. These estimates are generally consistent with the 4.3
to 4.4 hour/week attendance estimates from other groups (Jokitulppo
et al., 1997; Smith et al., 2000). Some nightclubs have live music
and when sound levels were measured at 8 live-music nightclubs in
New York City, the average sound levels during performances ranged
from ~95 to 107 dBA (Gunderson et al., 1997). When periods of no
live music were included in the calculations, average sound levels
were lower, ranging from ~92 to ~100 dBA (Gunderson et al., 1997).
Taken together, attendance time and sound levels are probably fairly
comparable for concerts and nightclubs, the noise dose accrued at either
venue likely falls within the same general range, and these exposures
likely reach or exceed the daily noise limit.
Sporting Events. Time spent at sporting events was reported to range
from 68 hours per year among transit users to 186 hours per year among
subjects that do not routinely use mass transit, for a New York City
population (Neitzel et al., 2011). There is not extensive literature on
sound levels at sporting events, however the available data are reviewed
here. Football. Engard et al. (2010) sampled sound levels at three
stadiums in Northern Colorado, including a “large-sized college football
stadium,” a “medium-sized college football stadium,” and a “National
Football League (NFL) stadium.” Average sound levels that fans were
exposed to in the stadiums were ~91 dBA (medium and large college
stadiums) to ~95 dBA (NFL stadium). After accounting for the duration
of the exposures, the 8-hr TWA calculated using OSHA guidelines was
85-86 dBA (62% to 66% daily dose), whereas the ACGIH 8-hr TWA
was 90-92 dBA (420-806% daily dose) (Engard et al., 2010). Hockey.
When sound levels were measured during three Stanley Cup hockey
play-off games, the average levels ranged from ~101 dBA to ~104 dBA,
with occasional peaks exceeding 120 dBA (Hodgetts & Liu, 2006).
Game durations were approximately 3 hours, and temporary changes in
threshold sensitivity were measured in the two attendees tested. Golf.
A single case report describes a patient with a permanent audiometric
notch, consistent with NIHL, after a reported exposure in the form of
golfing with a titanium club that produced a sound “like a gun going
off” upon impact with the ball (Buchanan et al., 2008). Buchanon et
al. (2008) measured peak sound levels on impact for a variety of steel
and titanium golf clubs, and reported levels of 120-130 dB peak SPL.
Music Players and Hearing. It has been widely suggested that modern
digital audio players are potentially more dangerous than the personal
stereos of previous generations due to their smaller size, convenience,
larger storage capacity, longer battery life, and the capability of producing
high level sounds. Selected listening level and duration of use per day
are critical, as are duration of time over which the behavior is repeated
and exposure to other noise sources. All of these factors interact to
determine the potential for changes in hearing over time (for excellent
recent reviews, see Levey et al., 2011; Portnuff et al., 2011). It is beyond
the scope of this brief review to identify all of the excellent work in this
area. Therefore it will simply be noted that listening levels measured in
a variety of adolescent and adult populations have typically averaged
around 70-75 dBA in-ear level in quiet settings, and around 90 dBA
in-ear level when measured in noise backgrounds. Across studies, a
small subset of any given population typically prefers higher music
levels (100-120 dBA in-ear level).
Summary and Conclusions
NIHL continues to be a problem for workers in a variety of industries
as well as military personnel despite the required use of HPDs. Correct
fitting and use of HPDs are of course a challenge, but the role of nonoccupational noise may need additional attention during discussions of
worker hearing loss prevention. While many non-occupational noises
are not likely to be encountered at a high-enough level or for a long
enough duration on such a frequently repeated basis that they would
be considered hazardous by the occupational hazard definition, they do
add to total daily and weekly exposure. For a worker who experiences
loud sound at work, the additional impact of the non-occupational noise
may be much more significant than the same non-occupational noise
insult would be for another individual not exposed to chronic workrelated noise. Workers should be counselled that non-occupational
noise that may not be hazardous on its own has the potential to increase
the overall risk of NIHL over time.
References
Behar A. 2007. Hockey playoff noise. CMAJ, 176, 1462.
Buchanan M.A., Wilkinson J.M., Fitzgerald J.E. & Prinsley P.R. 2008. Is golf bad
for your hearing? BMJ, 337, a2835.
Cabot R.C., Genter II R. & Lucke T. 1979. Sound levels and spectra of rock
music. Journal of the Audio Engineering Society, 27, 267-284.
Engard D.J., Sandfort D.R., Gotshall R.W. & Brazile W.J. 2010. Noise exposure,
characterization, and comparison of three football stadiums. J Occup Environ
Hyg, 7, 616-621.
Gunderson E., Moline J. & Catalano P. 1997. Risks of developing noise-induced
hearing loss in employees of urban music clubs. Am. J. Ind. Med., 31, 75-79.
Hodgetts W.E. & Liu R. 2006. Can hockey playoffs harm your hearing? CMAJ,
175, 1541-1542.
Jokitulppo J.S., Bjork E.A. & Akaan-Penttila E. 1997. Estimated leisure noise
exposure and hearing symptoms in Finnish teenagers. Scand. Audiol., 26, 257-262.
Levey S., Levey T. & Fligor B.J. 2011. Noise exposure estimates of urban MP3
player users. J. Speech. Lang. Hear. Res., 54, 263-277.
Müller J., Dietrich S. & Janssen T. 2010. Impact of three hours of discotheque
music on pure-tone thresholds and distortion product otoacoustic emissions. J.
Acoust. Soc. Am., 128, 1853-1869.
Neitzel R.L., Gershon R.R., McAlexander T.P., Magda L.A. & Pearson J.M.
2011. Exposures to Transit and Other Sources of Noise among New York City
Residents. Environ Sci Technol, 46, 500-508.
NIOSH 1998. Criteria for a Recommended Standard, Occupational Noise
Exposure, DHHS (NIOSH) Publication No.98-126.
Opperman D.A., Reifman W., Schlauch R. & Levine S. 2006. Incidence of
spontaneous hearing threshold shifts during modern concert performances.
Otolaryngol. Head Neck Surg., 134, 667-673.
OSHA 1983. 29 CFR 1910.95. Occupational Noise Exposure; Hearing
Conservation Amendment; Final Rule, effective 8 March 1983. U.S. Department
of Labor, Occupational Safety & Health Administration.
Portnuff C.D., Fligor B.J. & Arehart K.H. 2011. Teenage use of portable listening
devices: a hazard to hearing? J. Am. Acad. Audiol., 22, 663-677.
Serra M.R., Biassoni E.C., Richter U., Minoldo G., Franco G., et al. 2005.
Recreational noise exposure and its effects on the hearing of adolescents. Part I:
an interdisciplinary long-term study. Int. J. Audiol., 44, 65-73.
Smith P.A., Davis A., Ferguson M. & Lutman M.E. 2000. The prevalence and
type of social noise exposure in young adults in England. Noise Health, 2, 41-56.
Williams W., Beach E.F. & Gilliver M. 2010. Clubbing: the cumulative effect of
noise exposure from attendance at dance clubs and night clubs on whole-of-life
noise exposure. Noise Health, 12, 155-158.
Dr. Le Prell is currently a professor at the University of Texas at Dallas, and one of the
leading researchers in the area of hearing loss prevention. Her work has emphasized the
identification of cell death pathways activated by noise, and assessment of therapeutic
agents that prevent cell death and hearing loss. Before joining UT Dallas, Dr. Le Prell
served as interim chair of the Department of Speech, Language and Hearing Sciences
at the University of Florida. - UT Dallas School of Behavioral and Brain Sciences
CAOHC
update
4
2016—Vol. 28, Issue 1
The Importance of Detecting Temporary Threshold Shifts
By Matthew Williams, AuD
The primary goal of a hearing conservation program is to prevent noiseinduced hearing loss. The principal method to accomplish this is by
controlling the noise at its source by utilizing engineering controls to
reduce the noise level. Secondary to noise source management, reducing
the risk of noise-induced hearing loss involves the use of hearing protection
by workers. To ensure compliance with personal protective equipment
use, signs are placed in hazardous noise areas to remind workers to wear
earplugs or earmuffs; workers are educated and trained on when, why,
and how to wear hearing protection. Administrative action may even
be used for non-compliant workers. Yet, there are still a vast number
of permanent threshold shifts with workers exposed to noise. Through
appropriate timing of the annual test and follow-up monitoring of hearing
levels after a significant threshold shift is detected, temporary changes in
hearing can be identified to support the existing preventative measures.
Noise-exposed workers receive a baseline hearing test and periodic
hearing tests, at least annually thereafter, in order to detect any change
in hearing. The goal is the early identification of noise damage to prevent
any permanent hearing loss. However, all too often the annual hearing
test is simply used as a tracking tool to document hearing loss over time
for individuals or groups of people for record keeping and trend analysis.
Unfortunately, the purpose of hearing testing is often to check the box
and meet the testing requirements with little regard to investigation of
why an individual’s hearing has changed. Investigation and prevention
need to come before a permanent shift occurs.
Noise-induced hearing loss is preventable if the worker wears hearing
protective devices when and how they are supposed to be wearing them.
If a permanent threshold shift exists, it is probably not from just one
exposure to loud noise, with exception to blasts and explosions. It is
most likely due to repeated improper use of hearing protection in noisy
situations. Auditory fatigue is bound to occur after being in the noisy
workplace without proper protection. Therefore, the best time to detect
this temporary shift in hearing would be near the end of a work cycle.
The Occupational Health and Safety Administration (OSHA) requires a
14-hour noise-free period before the baseline hearing test is performed,
but it does not give specifications for noise exposure before the annual
test.(1) However, the National Institute for Occupational Safety and Health
(NIOSH) recommends the annual test be completed during or at the end of
a work shift (after noise exposure) to detect any signs of auditory fatigue.
(2)
If no shift in hearing thresholds is noted after working in the noisy
environment, it can be assumed that the worker is properly protected in
that workplace. However, if there is a shift in hearing thresholds during
this annual test, it is unknown at this point if it is a temporary shift due
to auditory fatigue or if it is permanent. Another hearing test should
be administered to the worker after a period of auditory rest. NIOSH
recommends at least 12 hours of quiet prior to the follow-up test.(2) If
the threshold shift on this “follow-up” hearing test is no longer present,
the examiner assumes it was a temporary hearing loss, most likely due
to improper protection while working in noise.
Department of Defense hearing conservation programs require a follow-up
test after any significant shift in hearing(3), but most hearing conservation
programs in an industrial setting do not include retesting because OSHA
does not require it.(1) In these cases the professional supervisor must either
assume the shift in hearing is already permanent and reset the baseline, or
refer the worker for additional testing with an audiologist. In some cases,
a prompt follow-up test would have eliminated the need for an audiology
or professional supervisor referral after identifying the temporary shifts.
According to a 2014 United States Air Force report, 3.25% of all workers
on the hearing conservation program had a temporary threshold shift in
2013.(4) Although the percentage seems low, it was over 4,000 workers who
experienced a temporary shift in hearing, potentially due to auditory fatigue
after improperly protecting their hearing while exposed to hazardous noise.
That’s 4,000 people being retrained on the proper use of hearing protection
to prevent the shift in hearing from becoming a permanent hearing loss!
So the question remains, are OHCs performing annual hearing tests because
it is required by OSHA, or performing the test as a tool for prevention?
If the goal truly is prevention, then OHCs should be looking for those
temporary shifts in hearing thresholds. Hearing conservationists should
perform the annual hearing test toward the end of the workday after the
worker has been exposed to noise, performing a follow-up test on any
worker who shows a significant shift in hearing.
During an informal inquiry with OHCs during CAOHC recertification
courses, I learned that several of the recertifying OHCs were being told
by their professional supervisor to require a noise-free period prior to
all tests to cut down on the number of repeat tests they are doing. While
this may save a little time with the handful of follow-up audiograms,
they are missing the opportunity to intervene with workers who may
not be adequately protected. The result might result in an increase in
permanent threshold shifts in the future, which might also increase the
time and money spent on new, permanent, work-related hearing losses. Is
the purpose of monitoring audiometry hearing loss prevention or merely
an exercise in record-keeping?
The views expressed are those of the author and do not necessarily reflect
the official policy or position of the Air Force, the Department of Defense,
or the U.S. Government.
References
Occupational Safety and Health Administration. Occupational noise exposure.
Audiometric testing program. (n.d.). 29 CFR 1910.95(g).
National Institute for Occupational Safety and Health. Criteria for recommended
standards: occupational noise exposure. Cincinnati (OH): NIOSH; 1998:49-50.
U.S. Air Force. Occupational noise and hearing conservation program.
Washington (DC): Department of the Air Force; 2013 May 10. Air Force
Occupational Safety and Health Standard 48-20.
Hecht Q, Waldrop C, Williams M. USAF hearing conservation program, DOEHRS
data repository annual report: CY 2013. Wright-Patterson AFB (OH): U.S. Air Force
School of Aerospace Medicine; 2014. AFRL-SA-WP-TP-2014-0001. [Accessed 2
Jul 2015]. Available from www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA611096.
Matt Williams has been a CAOHC Course Director since 2008. Dr. Williams has
served in the Air Force as an Audiologist for ten years and has certified hundreds of
public health technicians as hearing conservationists. He has been instrumental in
the improvement of the AF Hearing Conservation Program during his time at the AF
School of Aerospace Medicine. Dr. Williams is currently a Pediatric Audiologist and
devotes much of his time to hearing conservation in children and teens.
CAOHC
2016—Vol. 28, Issue 1
update
5
The Effect of Education on the Decision to Wear Ear Plugs
By Elizabeth Marler, Purdue University
From a young age, children learn to brush their teeth every day and to
sit through regular eye examinations. Unfortunately, the same kind of
lifelong education is lacking for auditory health. We use Q-tips regularly
and attend concerts without protection — habits that unknowingly
leave us susceptible to auditory damage. What if information about
general ear health were provided? Would awareness catalyze action
to prevent damage to hearing? How does access to resources change
health behavior?
College students are a population at high risk for noise-induced hearing
loss due to noise exposure at bars, concerts, workout classes, and
sporting events. Beyond a general risk, over half of college students
voluntarily expose themselves to harmful levels of music and noise.1
The reality of college students elevated risk to hearing damage raises
the following important research questions: Are college students taking
preventative action to protect their hearing? What would motivate
them to do so? My three-part study evaluated the decisions of college
students to wear or not wear hearing protective devices when attending
on-campus music concerts.
The first part of the study took place at a concert at a private Midwestern
university. An exit survey, completed by 149 students, gauged how
much students knew about auditory health, the dangers of loud music,
and their decisions to wear or not wear ear plugs. The students attending
the concert were not given any information about the risk of entering
without hearing protection nor were they provided with ear plugs.
The results were unsurprising. Only five percent of students reported
wearing hearing protection during the concert.
Part two of the study was conducted at the following campus-wide
concert. A group of 36 students attended a voluntary session before
the concert on noise-induced hearing loss and the harmful effects of
attending the concert without protection. The students were provided
with ear plugs. After the concert, the students took a survey which
asked whether they wore the ear plugs that were provided and if there
Figure 2 Motivations for Wearing Hearing Protection or Not
Wore ear plugs:
36.8% The ear plugs were free, why not?
28.9% Concerts are too loud for me and I wanted to muffle the noise
13.2% I learned about the dangers of noise-induced hearing loss
today and wanted to protect my ears
7.24% I always wear ear plugs when in noise because I’m
concerned about developing hearing loss
Did not wear ear plugs:
26.3% Music sounds distorted when I wear ear plugs
24.3% Uncomfortable to wear
7.9% Unattractive cosmetic appeal
3.9% Did not know ear plugs were available
were any noticeable changes in their hearing abilities as a result of
the concert. The results from the second part of the study showed that,
with face-to-face education and the provision of free ear plugs, over
half (55.6%) of the students reported wearing hearing protection at
the concert. Education and resources together catalyzed preventative
action in a high-risk population.
However, would the strategy be as effective without a face-to-face
presentation on noise-induced loss? The last part of the study, conducted
at the succeeding concert, employed a different educational strategy.
Signs and handbills displayed noise-induced hearing loss facts as
well as risks of attending the concert without protection. Over 2,000
students walked by the signs and picked up the handbills, three-fourths
of those picking up a pair of ear plugs on their way into the concert
venue. Volunteers were available to demonstrate or assist on how to
properly insert the ear plugs. As attendees exited the venue, a survey
evaluated whether the attendee wore the ear plugs, why or why not,
and if there were any noticeable changes in hearing abilities as a result
of the concert. Of the 152 students surveyed, almost 50% reported to
have worn ear plugs at the concert (see Figure 1).
Why did students choose to wear or not wear free ear plugs provided
on-site? The majority of college students reported their motivation to
wear ear plugs came from the availability of resources and the loud
concert environment. A smaller percentage chose not to wear hearing
protection because ear plugs distorted the quality of the music and made
it difficult to converse with friends. Overall, the top two concerns that
students identified as reasons to not wear ear plugs (“Music sounds
distorted…” and “Uncomfortable to wear”) could be addressed by
the use of musician’s ear plugs. Unlike the standard (and highly
affordable) plugs used in the present study, musician’s ear plugs, which
fit comfortably in the canal, would allow for sound to be attenuated
without appreciable reduction in sound quality.
continued on page 6
CAOHC
update
6
2016—Vol. 28, Issue 1
– continued from page 5: The Effect of Education on the Decision to Wear Ear Plugs...
As audiologists attempt to broaden awareness of the field while
encouraging preventative health behaviors, it is important to evaluate
whether national educational campaigns could have a significant impact
on changing attitudes and actions towards auditory health. The results
of the study suggest that, at least in the setting of campus concerts,
providing education and resources has an impact on an individual’s
decision to take preventative action for their auditory health. Faceto-face education, such as an in-person presentation, showed to be
more effective in motivating students to wear ear plugs than indirect
educational strategies, such as pamphlets. The availability and allocation
of resources is another important factor to consider for audiologists
interested in promoting public health. Beyond education strategies,
the present study suggests that, if resources to promote hearing health
are made available, individuals are likely to take advantage of them.
Evidence for the impact of education and resource allocation gives
promise to audiologists’ efforts to promote positive health behavior.
Perhaps it will be a hearing test that finally joins the ranks of other
annual doctor’s appointments.
References:
Rawool VW, Colligon-Wayne LA. Auditory lifestyles and beliefs related to
hearing loss among college students in the USA. Noise Health 2008;10:1-10
1
Author Bio:
Elizabeth Marler is a first year graduate student in the AuD program at Purdue
University in West Lafayette, IN. She is a graduate of Truman State University in
Kirksville, Missouri, where she conducted her research. Elizabeth has presented
this research at the 2015 Missouri Speech-Language-Hearing Association annual
conference, the 2015 American Speech-Language-Hearing Association annual
conference and will present at the American Academy of Audiology Conference in
April. [email protected]
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to the entire hearing conservation community. Each edition is posted on our new website,
reaching over 22,000 occupational hearing conservationists. Writing for UPDATE is your
chance to reach thousands of colleagues within the hearing conservation industry who are
committed to occupational Hearing Conservation, just like you!
Articles that will be selected must complement CAOHC’s mission and goals, as well as be
relevant. We are interested in hearing about innovative hearing loss prevention programs, new
innovations in training employees to be hearing conservation compliant, your challenges and
your successes.
In addition, UPDATE places the “spotlight” on an outstanding Occupational Hearing
Conservationist, Course Director, or Professional Supervisor. If you know of someone in your
company deserves the “spotlight” for their commitment to hearing conservation, please craft
a brief testimonial (approximately 75-100 words or less) and include that person’s name, your
company name and a recent head-shot photo. Your “spotlight” candidate will be added to our
next issue, as well as, posted to the CAOHC website.
Submit your article or your “spotlight” testimonial along with your contact information to Kim
Stanton at [email protected], or our UPDATE Editor, Dr. Antony Joseph, at earsafety@
yahoo.com. Also, please let us know what you would be interested in reading in future issues
of UPDATE. You may send your comments or questions to the CAOHC Administrative Office
at [email protected]. Thank you again for your interest in UPDATE!
CAOHC
update
2016—Vol. 28, Issue 1
7
The Council for Accreditation in
Occupational Hearing Conservation
By Don Garvey, CSP, CIH; 3M Company; Personal Safety Division - Applications Engineering; St. Paul, MN
Noise-induced hearing loss (NIHL) is one of the most pervasive
occupational health illnesses in the manufacturing industry. Per
Bureau of Labor Statistics, occupational hearing loss accounts for
1 in 9 recordable illnesses in the industry. One method to reduce
NIHL is obviously to eliminate the noise exposure. However, this
is not always feasible. In this case, a high quality, effective hearing
conservation program (HCP) can be a significant factor in minimizing
NIHL in the workforce.
The question then becomes how to ensure a high quality HCP? The
Council for Accreditation in Occupational Hearing Conservation
(CAOHC) is a professional organization dedicated to providing
consumer safety and protection by offering credentialing to those
working to prevent noise-induced hearing loss. CAOHC does this by
providing credentialing in 3 areas of occupational hearing conservation.
The qualifications and requirements for credentialing listed below are
only an overview:
• Certified Occupational Hearing Conservationist (COHC) – the front
line person who meets with the worker, performs pre-audiometry
ear inspections, provides audiometric testing, does initial screening
for problem audiograms, conducts training in regard to audiometric
testing and the adverse effects of noise, use/fitting/care of hearing
protection, and may be involved in maintaining equipment and
recordkeeping. The COHC is not expected to interpret audiograms,
diagnose hearing disorders, conduct noise surveys or design noise
controls.
In a manufacturing facility, this may be the company nurse, safety
director or other person directly involved with audiometric testing.
Certification requires attending a CAOHC-approved 20-hour course
and passing a standardized examination.
• Professional Supervisor of the Audiometric Monitoring Program
(PS) – The PS establishes and oversees the audiometric testing
program ensuring proper equipment, testing, training and
recordkeeping protocols are developed and implemented. The PS
oversees the OHC’s work, reviews audiograms, makes required
baseline comparisons, and determines if any confirmed threshold
shift or hearing loss is work-related. If so, the PS sees that proper
worker notification, follow-up and entries into databases such as
the OSHA 300 log occur.
In a manufacturing facility, this may be the staff physician or an
audiologist or otolaryngologist that is retained by the employer.
Certification requires the candidate currently hold a license in the
practice of medicine or audiology, recommended completion of a
CAOHC-approved professional supervisor course and successful
completion of an examination.
• Course Directors (CD) – CAOHC-approved courses are conducted
by CAOHC trained Course Directors. CDs must have adequate
professional and educational backgrounds and be certified by
one of several different professional organizations (e.g. ABIH,
BCSP, licensed physician, nurse or audiologist). They must also
demonstrate a minimum of 1000 hours devoted to occupational
hearing conservation during the previous five years and complete
an 8-hour CAOHC CD workshop or equivalent. CAOHC provides
CDs with training resources and professional support to assist in
ensuring high quality training for OHCs.
The Hearing Conservation Manual, 5th Edition, is a common reference
for hearing conservationists, and is published by CAOHC. This manual
contains information on all aspects of occupational hearing conservation
– from anatomy of the ear to understanding audiograms to worker
training. The manual includes reference documents on industry specific
noise requirements such as the Mine Safety and Health Administration
30 CFR Part 62. The Hearing Conservation Study Guide is designed to
supplement the COHC course. CAOHC also publishes a free on-line
newsletter with short articles on occupational hearing conservation.
If your facility has a hearing conservation program that includes
audiometric testing, certification by CAOHC may be something to
investigate.
References
NIOSH Occupationally Induced Hearing Loss DHHS (NIOSH) Publication No.
2010-136
CAOHC website www.caohc.org
Register Now!
Professional Supervisor of the Audiometric
Monitoring Program Workshop
July 15, 2016 • Houston, TX & November 5, 2015 • Indianapolis, IN
Visit www.caohc.org to register
CAOHC
update
8
2016—Vol. 28, Issue 1
Suggested Reading
Submitted by Antony Joseph, Editor, CAOHC Update e-Newsletter
In August 2015, Plural Publishing released Medical-Legal Evaluation of Hearing Loss, Third
Edition, authored by Robert A. Dobie MD. For many years, this text has served as a comprehensive
medical-legal resource for attorneys, physicians, and audiologists. When the first edition of
his book was released, Dr. Dobie was a representative on CAOHC’s Council for the American
Academy of Otolaryngology - Head and Neck Surgery. He is currently a clinical professor of
otolaryngology at both the University of Texas Health Science Center at San Antonio (UTHSCSA)
and the University of California, Davis, as well as a partner in Dobie Associates providing
consultation in hearing, balance, hearing conservation, and ear disorders.
This exceptional book includes the most accurate and current developments in the field with
more than 250 new references. A comprehensive guide on hearing loss and the law, MedicalLegal Evaluation of Hearing Loss examines claims, court cases, and the evolution of hearing
conservation. It extensively addresses age-related hearing loss, genetics of hearing loss, and noiseinduced hearing loss (NIHL) with a newly revised international standard (ISO-1999, 2013) that
presents a comprehensive predictive model for NIHL, critical in medical-legal evaluation. Also
examined is hearing loss due to toxins, trauma, and disease as well as the effects of cardiovascular
risk factors, race, and socioeconomic status. Dr. Dobie has included tutorial discussions of acoustics, hearing, and hearing testing - a valuable
resource for attorneys, paraprofessionals, and other non-clinicians.
New or expanded topics include: (1) the relationship of hearing loss to brain disorders, (2) job fitness, (3) accommodations under the Americans
with Disabilities Act, (4) blast injury, (5) recreational music and hearing loss, (6) hypothesis of progressive NIHL after noise cessation, (7) solvent
ototoxicity, (8) appropriate exchange rate for predicting noise hazard, and (9) the American Medical Associations method of measurement of
hearing disability. The new edition of Medical-Legal Evaluation of Hearing Loss provides practical guidance for expert witnesses and legal
practitioners, and is essential for otolaryngologists, audiologists, occupational physicians, attorneys handling hearing loss claims, and claims
management professionals.
Reference information:
Medical-Legal Evaluation of Hearing Loss, Third Edition | Author: Robert A. Dobie, MD | Published: 07/15/2015 | ISBN: 978-1-59756-714-5
| http://www.pluralpublishing.com/publication_mlehl3e.htm
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CAOHC
update
2016—Vol. 28, Issue 1
9
Leadership
The CAOHC leadership otherwise known as the Council consists of two representatives from each
of the following Component Professional Organizations (CPO).
• American Association of Occupational Health Nurses
(AAOHN)
Elaine Brown, RN BS COHN-S/CM COHC
Bryan Topp, RN MPH COHN-S COHC
• American Industrial Hygiene Association (AIHA)
Chandran Achutan, PhD
Council Vice Chair
Karin Wetzel, MSPH CIH SGE FAIHA
• American Academy of Audiology (AAA)
Laurie Wells, AuD FAAA CPS/A
Council Chair
Antony Joseph, AuD PhD CPS/A
• American Speech-Language-Hearing Association
(ASHA)
Pamela duPont, MS CCC-A CPS/A
Ted Madison, MA CCC-A
• American Academy of Otolaryngology - Head & Neck
Surgery (AAO-HNS)
LTC James Crawford, MD CPS/A
Col Mark Packer, MD USAF MC FS
• Institute of Noise Control Engineering (INCE)
Charles Moritz, MS INCE Bd Cert.
Council Secretary /Treasurer
Kimberly Riegel, PhD
• American College of Occupational and Environmental
Medicine (ACOEM)
D. Bruce Kirchner, MD MPH CPS/A
Council Past Chair
MAJ Raúl Mirza, MS DO MPH
• Military Audiology Association (MAA)
LTC J. Andy Merkley, AuD CCC-A CPS/A
Council Vice Chair-Education
Maj John Foster, USAF BSC CCC-A
• American Society of Safety Engineers (ASSE)
Donald Garvey, CIH CSP
Brent Charlton CSP
To submit an article for publication to a future issue of Update
contact the CAOHC Administrative Office at [email protected].
555 E. Wells St.
Suite 1100
Milwaukee, WI 53202
(414) 276-5338
www.caohc.org
CAOHC-0316-003